DR. ALICIA MANDUJANO (NPI# 1114106119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114106119 |
| Entity Type | Individual |
| Full Name | DR. ALICIA MANDUJANO |
| Credential | M.D. |
| Practice Address |
3000 N Halsted St Suite 209-a Chicago IL 60657-5188 |
| Practice Telephone | 7732967660 |
| Mailing Telephone | 7732967660 |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2018-10-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 036.121395 | IL | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 35.094008 | OH | Allopathic & Osteopathic Physicians |
| Street Address |
3000 N HALSTED ST SUITE 209-A |
| City | CHICAGO |
| State | IL |
| Zip Code | 60657-5188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053310482 | Mark Pietz | Podiatrist | 3000 N Halsted St, Suite 821, Chicago, IL 60657-5188 | 2005-07-18 |
| 1740844232 | Sandra Mazzeffi | Nurse Practitioner | 3000 N Halsted St, Chicago, IL 60657-5188 | 2019-04-30 |
| 1437713930 | Molly O'brien | Physician Assistant | 3000 N Halsted St, Chicago, IL 60657-5188 | 2019-04-30 |
| 1245760081 | Carolina Coello | Nurse Practitioner | 3000 N Halsted St, Chicago, IL 60657-5188 | 2017-06-14 |
| 1417302704 | Brittany Beeg | Audiologist | 3000 N Halsted St, Suite 400, Chicago, IL 60657-5188 | 2016-04-25 |
| 1063870525 | Whitney Fritzie | Specialist | 3000 N Halsted St, Suite 320, Chicago, IL 60657-5188 | 2016-01-29 |
| 1952776445 | Alissa Roberts | Nurse Practitioner | 3000 N Halsted St, Suite 723, Chicago, IL 60657-5188 | 2015-12-09 |
| 1366815250 | Windy City Pediatrics | Clinic/Center | 3000 N Halsted St, Suite 825, Chicago, IL 60657-5188 | 2015-11-02 |
| 1346640828 | Ellen May | Audiologist | 3000 N Halsted St, Suite 400, Chicago, IL 60657-5188 | 2014-09-03 |
| 1558771543 | Anthony Lisuzzo | Physician Assistant | 3000 N Halsted St, Suite #525, Chicago, IL 60657-5188 | 2014-04-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303887 | Simone Paes | Behavior Technician | 3141 N Sheffield Ave, Chicago, IL 60657 | 2020-10-13 |
| 1821613175 | Samridhi Khatri | Internal Medicine | 836 W. Wellington Ave, Advocate Illinois Masonic Medica, Suite 1312, Chigaco, IL 60657 | 2020-06-12 |
| 1467074617 | Dewolfe Aesthetic Services Sc | Surgery | 3357 N. Southport Aveune, Chicago, IL 60657 | 2020-05-11 |
| 1790304657 | Mehr Amer Mjeed | Student in an Organized Health Care Education/Training Program | Advocate Internal Medicine Clinic, Advocate Illinois Ma, 836 West Wellington Avenue, Chicago, IL 60657 | 2020-04-10 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1306493408 | Art of Sight Eyecare, LLC | Optometrist | 2915 N. Broadway, Chicago, IL 60657 | 2019-08-22 |
| 1992359277 | Joseph Michael Rochford IIi | Counselor | 1358 W Belmont Ave, Unit # 202, Chicago, IL 60657 | 2019-07-25 |
| 1487116240 | Conrad Petersen Dermatology Sc | Dermatology | 2845 N Sheridan, Chicago, IL 60657 | 2019-04-02 |
| 1003388810 | Evolve Wellness S.c. | Counselor | 2845 North Sheridan Road, Suite 708, Chicago, IL 60657 | 2018-12-19 |
| 1639657414 | Advocate North Side Health Network | Psychiatric Unit | 836 W Wellington Ave., Chicago, IL 60657 | 2018-08-02 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699382531 | Contemporary Ob/gyn Chicago, Pllc | Obstetrics & Gynecology | 2007 S State St, Chicago, IL 60616-2173 | 2020-09-24 |
| 1831711381 | Baillie Anne Bronner | Obstetrics & Gynecology | 1653 W Congress Pkwy Chicago, Il 60612, Chicago, IL 60612 | 2020-05-07 |
| 1679003826 | Scolastica W Njoroge | Obstetrics & Gynecology | 5841 S Maryland Ave Rm J-141, Chicago, IL 60637-1447 | 2017-06-19 |
| 1356794457 | Paige Dermer Kendall | Obstetrics & Gynecology | 250 E. Huron Street, Chicago, IL 60611 | 2016-07-13 |
| 1427409093 | Marly Francois | Obstetrics & Gynecology | 1300 W Belmont Ave Ste 100, Chicago, IL 60657-3200 | 2016-06-24 |
| 1346695509 | Kristina Janea Warner | Obstetrics & Gynecology | 250 E Superior St Ste 5-2166, Chicago, IL 60611-2914 | 2016-04-25 |
| 1962857102 | Jacqueline Christine Lee | Obstetrics & Gynecology | 250 E Superior St Ste 5-2177, Chicago, IL 60611-2914 | 2016-04-25 |
| 1881049120 | Kelly Ann Davis | Obstetrics & Gynecology | 7447 W Talcott Ave Ste 531, Chicago, IL 60631-3716 | 2016-04-24 |
| 1780046185 | Hillary Edelman | Obstetrics & Gynecology | 900 N Kingsbury St Ste 130n, Chicago, IL 60610-7457 | 2016-03-24 |
| 1578929139 | Olivia Helen Finkelstein Barry | Obstetrics & Gynecology | 675 N Saint Clair St # 200, Chicago, IL 60611 | 2016-01-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.